Utah Renewal Instructions

Transcription

1 Utah Renewal Instructions For 2 50 Eligible Employees Effective August 1, 2009 Easy steps to renew your coverage UT A (5/09)

2 Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. The Aetna company that offers, underwrites or administers benefit coverage is Aetna Life Insurance Company (Aetna).

3 It s renewal time, with Aetna Aetna makes the renewal process easy Dear Valued Aetna Customer: We appreciate your business and look forward to renewing your health insurance benefits. If you are pleased with your current plan and don t wish to make changes the renewal process is complete and your coverage will automatically renew prior to the effective date. Aetna Avenue SM Your Destination for Small Business Solutions SM You ll notice a new look and feel with the materials you receive from us this year. Aetna Avenue is our commitment to value for your premium dollars. Whether or not you decide to make any medical health insurance plan changes, you and your employees will have continued access to all of our value-add discount programs and health resources, including our award-winning member website, Aetna Navigator. Aetna Avenue also means access to care from Utah s largest health provider network and the flexibility of Pick-A-Plan 3. With the option to choose any 2-3 plans from our 2009 portfolio, you control of the bottom line while providing employees superior health benefits coverage. This booklet serves as your guide to complete your 2009 renewal. If you have questions or need more information, contact your benefits producer or Aetna Small Group at , prompt #1. We understand you have a choice of carriers and thank you for placing your confidence in Aetna. Sincerely, Gary Mizell Vice President and Market Head of Sales and Service Aetna Small and Middle Market Business Arizona, Nevada and Utah 1

4 Contact information Aetna Small Group Broker & General Agents Broker sales support unit phone fax Choose the following numbers, when prompted, to access the information you need. 1 If you know your party s extension 2 Claims 3 Commissions 4 Licensing and Appointment 5 Billing, Enrollment and Eligibility 6 Broker Liaison Address Utah: ASGBLUT@aetna.com Regular Mail P.O. Box Fresno, CA Overnight Mail 1385 East Shaw Avenue Fresno, CA New Business Quoting Utah: phone fax ASGQuoteUT@aetna.com New Business Case Submission Aetna New Business Underwriting P.O. Box Fresno, CA Aetna Navigator & Producer World Monday Friday 7:00 a.m. 9:00 p.m. ET Choose the following numbers, when prompted, to access the information you need. Prompt 1 (Aetna Navigator) Prompt 3 (Producer World) 1 Assistance with password or user name 2 Assistance with registration 3 Access assistance 4 All other website technical assistance plan sponsor services phone fax Choose the following numbers, when prompted, to access the information you need. 1 Renewals 2 Claims 3 Billing & Enrollment Billing For Lockbox information, see customer bill or please contact the Plan Sponsor Services toll-free number for more information. Enrollment Aetna P.O. Box Fresno, CA

5 Member Services Medical (prompt 1) For benefit questions or claims for Aetna PPO Plan, Aetna Indemnity Plan Claims Addresses For Aetna PPO Plan, Aetna Indemnity Plan Aetna P.O. Box El Paso, TX dental Prompt 1 (Dental Plan Member) Prompt 2 (Dental Care Provider) Claims Address Aetna P.O. Box Lexington, KY Life Claims Address Aetna Life Insurance P.O. Box Lexington, KY pharmacy AETNA RX or Prompt 2 (Member or Calling on Behalf of a Member) Claims Address Aetna Pharmacy Management Attn: Claims P.O. Box Lexington, KY Fax: Mail-Order Drug Ordering Address Aetna Rx Home Delivery P.O. Box Kansas City, MO other programs Aetna Vision SM Discount Program Call for closest eye care provider Informed Health Line Hour Nurse Help Line Aetna Behavioral Health Please call the number on your Member ID card. Alternative Health Care Programs, Fitness Program, DocFind, Aetna Navigator and Other Information Information can be accessed through our website at Aetna.com. 3

6 How to renew your Aetna health plans To keep your existing benefits AND select an alternate plan(s) n Please check off the Renewal plan and also check off any Alternate plans you d like to add on the Plan Sponsor Signature Page in your renewal packet and fax it to n Please submit a letter or list of employees to identify the correct plan selection of all employees. To delete your existing benefits and move to an alternate plan(s) n Please check off any Alternate plans you d like to add on the Plan Sponsor Signature Page in your renewal packet and fax it to n Please submit a letter or list of employees to identify the correct plan selection of all employees. To request an upgrade in benefits not listed in your renewal If you re not enrolled in Pick-A-Plan 3, medical underwriting is required on all upgrade requests and may be declined. n Please submit a letter on company letterhead requesting the upgraded plan(s). n Employee Change of Coverage Form, with the medical question completed only for those employees wishing to move. n A completed Employer Application (pages 1 and 4). n Copy of the most recent filed 3H. n Please fax all information to All items (completed in full) are to be received by Aetna no later than the day before the requested effective date. Ancillary adds need to be submitted 15 days in advance of the requested effective date. Correspondence can also be mailed to: Aetna P.O. Box Fresno, CA TRADITIONAL PLATFORM PPO Plans PPO HDHP Plans Indemnity Plans 4

7 2009 Summary Comparison Aetna has redesigned several of our 2008 plans and developed new options for 2009 to provide greater choice, simplicity and affordability to meet your health benefit needs. Please refer to the guide below to determine how your current benefit plan is changing for Your Current Plan Your Renewal Plan Changes PPO /60 compared to PPO /60 See page 6 PPO /60 compared to PPO /60 See page 7 PPO /60 compared to PPO /60 See page 8 PPO /60 compared to PPO /60 See page 9 PPO /60 compared to PPO /60 See page 10 PPO /60 compared to PPO /60 See page 11 PPO % compared to PPO /60 See page 12 PPO % compared to PPO /60 See page 13 HDHP % compared to % HSA See page 14 HDHP % compared to % HSA See page 15 HDHP % compared to % HSA See page 16 HDHP % compared to % HSA See page 17 HDHP % compared to % HSA See page 18 Limited Benefit 50/50 compared to LIMITED BENEFIT 50/50 See page 19 Basic 1500 compared to BASIC 1500 See page Indemnity compared to INDEMNITY See page 21 NEW AETNA BENEFIT PLANS EFFECTIVE AUGUST 1, 2009 PPO 750 VALUE See page 22 PPO 1000 VALUE See page 23 PPO 1500 VALUE See page 24 PPO /60 See page 25 PPO 10, % See page 26 UTAH 2500 COINSURANCE See page 27 5

8 PPO /60 Compared to PPO /60 Current Plan Renewal Plan Plan Name PPO /60 PPO /60 Benefit In-Network Out of Network In-Network Out of Network Lifetime Maximum $2,000,000 $2,000,000 and Immunizations) $10 copay 40% after deductible $10 copay 40% after deductible $20 copay 40% after deductible $20 copay 40% after deductible $20 copay 40% after deductible $20 copay 40% after deductible $250 per member $500 per member $250 per member Coinsurance 20% 40% 20% 40% (excludes deductible) $1,500 per member $3,000 per member $1,500 per member $500 per member $3,000 per member Outpatient Lab $0 copay 40% after deductible $0 copay 40% after deductible Outpatient X-ray $0 copay 40% after deductible $0 copay 40% after deductible Outpatient Complex Imaging 30% after deductible 50% after deductible 30% after deductible 50% after deductible Hospital Inpatient 20% after deductible 40% after deductible 20% after deductible 40% after deductible 20% after $100 copay (deductible waived) Paid as in-network 20% after $100 copay (deductible waived) Paid as in-network Prescription Drugs $10/$30/$50 $10/$30/$ % $10/$30/$50 $10/$30/$ % Self Injectables (retail and mail order) 50% 50% 20% 20% The limits on Hospice Care and Mental Health have been removed. 6

9 PPO /60 Compared to PPO /60 Current Plan Renewal Plan Plan Name PPO /60 PPO /60 Benefit In-Network Out of Network In-Network Out of Network Lifetime Maximum $2,000,000 $2,000,000 and Immunizations) $15 copay 40% after deductible $15 copay 40% after deductible $25 copay 40% after deductible $25 copay 40% after deductible $25 copay 40% after deductible $25 copay 40% after deductible $500 per member $1,000 per member $500 per member Coinsurance 20% 40% 20% 40% (excludes deductible) $2,000 per member $4,000 per member $2,000 per member $1,000 per member $4,000 per member Outpatient Lab $0 copay 40% after deductible $0 copay 40% after deductible Outpatient X-ray $0 copay 40% after deductible $0 copay 40% after deductible Outpatient Complex Imaging 30% after deductible 40% after deductible 30% after deductible 50% after deductible Hospital Inpatient 20% after deductible 40% after deductible 20% after deductible 40% after deductible 20% after $150 copay (deductible waived) Paid as in-network 20% after $150 copay (deductible waived) Paid as in-network Prescription Drugs $10/$30/$50 $10/$30/$ % $10/$30/$50 $10/$30/$ % Self Injectables (retail and mail order) 50% 50% 20% 20% The limits on Hospice Care have been removed. 7

10 PPO /60 Compared to PPO /60 Current Plan Renewal Plan Plan Name PPO /60 PPO /60 Benefit In-Network Out of Network In-Network Out of Network Lifetime Maximum $2,000,000 $2,000,000 and Immunizations $15 copay 40% after deductible $15 copay 40% after deductible $25 copay 40% after deductible $25 copay 40% after deductible $25 copay 40% after deductible $25 copay 40% after deductible $750 per member $1,500 per member $750 per member Coinsurance 20% 40% 20% 40% (excludes deductible) $2,250 per member $4,500 per member $2,250 per member $1,500 per member $4,500 per member Outpatient Lab $0 copay 40% after deductible $0 copay 40% after deductible Outpatient X-ray $0 copay 40% after deductible $0 copay 40% after deductible Outpatient Complex Imaging 30% after deductible 50% after deductible 30% after deductible 50% after deductible Hospital Inpatient 20% after deductible 40% after deductible 20% after deductible 40% after deductible 20% after $150 copay (deductible waived) Paid as in-network 20% after $150 copay (deductible waived) Paid as in-network Prescription Drugs $15/$30/$50 $15/$30/$50 +20% $15/$30/$50 $15/$30/$50 +20% Self Injectables (retail and mail order) 50% 50% 20% 20% The limits on Hospice Care have been removed. 8

11 PPO /60 Compared to PPO /60 Current Plan Renewal Plan Plan Name PPO /60 PPO /60 Benefit In-Network Out of Network In-Network Out of Network Lifetime Maximum $2,000,000 $2,000,000 and Immunizations) $20 copay 40% after deductible $20 copay 40% after deductible $30 copay 40% after deductible $30 copay 40% after deductible $30 copay 40% after deductible $30 copay 40% after deductible $1,000 per member $2,000 per member $1,000 per member Coinsurance 20% 40% 20% 40% (excludes deductible) $2,500 per member $5,000 per member $2,500 per member $2,000 per member $5,000 per member Outpatient Lab $0 copay 40% after deductible $0 copay 40% after deductible Outpatient X-ray $0 copay 40% after deductible $0 copay 40% after deductible Outpatient Complex Imaging 30% after deductible 50% after deductible 30% after deductible 50% after deductible Hospital Inpatient 20% after deductible 40% after deductible 20% after $150 copay (deductible waived) Paid as in-network 20% after $150 copay (deductible waived) Paid as in-network Prescription Drugs $15/$30/$60 $15/$30/$ % $15/$30/$60 $15/$30/$ % Self Injectables (retail and mail order) 50% 50% 20% 20% The limits on Hospice Care have been removed. 9

12 PPO /60 Compared to PPO /60 Current Plan Renewal Plan Plan Name PPO /60 PPO /60 Benefit In-Network Out of Network In-Network Out of Network Lifetime Maximum $2,000,000 $2,000,000 and Immunizations) $25 copay 40% after deductible $25 copay 40% after deductible $35 copay 40% after deductible $35 copay 40% after deductible $35 copay 40% after deductible $35 copay 40% after deductible $1,500 per member $3,000 per member $1,500 per member Coinsurance 20% 40% 20% 40% (excludes deductible) $3,000 per member $5,000 per member $3,000 per member $3,000 per member $5,000 per member Outpatient Lab $0 copay 40% after deductible $0 copay 40% after deductible Outpatient X-ray $0 copay 40% after deductible $0 copay 40% after deductible Outpatient Complex Imaging 30% after deductible 50% after deductible 30% after deductible 50% after deductible Hospital Inpatient 20% after deductible 40% after deductible 20% after deductible 40% after deductible 20% after $200 copay (deductible waived) Prescription Drugs* $15/$40/$60 Subject to $150 deductible Self Injectables (retail and mail order) Paid as in-network $15/$40/$ % Subject to $150 deductible 20% after $200 copay (deductible waived) Paid as in-network $15/$40/$60 $15/$40/$ % 50% 50% 20% 20% The limits on Hospice Care have been removed. *The Prescription Drug Deductible has been removed on the 2009 plan. 10

13 PPO /60 Compared to PPO /60 Current Plan Renewal Plan Plan Name PPO /60 PPO /60 Benefit In-Network Out of Network In-Network Out of Network Lifetime Maximum $2,000,000 $2,000,000 and Immunizations) $30 copay 40% after deductible $30 copay 40% after deductible $40 copay 40% after deductible $40 copay 40% after deductible $40 copay 40% after deductible $40 copay 40% after deductible $2,000 per member $4,000 per member $2,000 per member Coinsurance 20% 40% 20% 40% (excludes deductible) $3,500 per member $7,000 per member $3,500 per member $4,000 per member $7,000 per member Outpatient Lab $0 copay 40% after deductible $0 copay 40% after deductible Outpatient X-ray $0 copay 40% after deductible $0 copay 40% after deductible Outpatient Complex Imaging 30% after deductible 50% after deductible 30% after deductible 50% after deductible Hospital Inpatient 20% after deductible 40% after deductible 20% after deductible 40% after deductible 20% after $200 copay (deductible waived) Prescription Drugs* $20/$40/$60 Subject to $200 deductible Self Injectables (retail and mail order) Paid as in-network $20/$40/$ % Subject to $200 deductible 20% after $200 copay (deductible waived) Paid as in-network $20/$40/$60 $20/$40/$ % 50% 50% 20% 20% The limits on Hospice Care have been removed. *The Prescription Drug Deductible has been removed on the 2009 plan. 11

14 PPO % Compared to PPO /60 Current Plan Renewal Plan Plan Name PPO % PPO /60 Benefit In-Network Out of Network In-Network Out of Network Lifetime Maximum $2,000,000 $2,000,000 and Immunizations) $20 copay 25% after deductible $25 copay 40% after deductible $30 copay 25% after deductible $35 copay 40% after deductible $30 copay 25% after deductible $35 copay 40% after deductible $1,500 per member Three-member maximum $3,000 per member Three-member maximum $1,500 per member Coinsurance 0% 25% 20% 40% (excludes deductible) N/A $6,000 per member Three-member maximum $3,000 per member $3,000 per member $5,000 per member Outpatient Lab $0 copay 25% after deductible $0 copay 40% after deductible Outpatient X-ray $0 copay 25% after deductible $0 copay 40% after deductible Outpatient Complex Imaging 0% after deductible 25% after deductible 30% after deductible 50% after deductible Hospital Inpatient 0% after deductible 25% after deductible 20% after deductible 40% after deductible $200 copay Deductible waived Paid as in-network 20% after $200 copay Deductible waived Paid as in-network Prescription Drugs $15/$30/$60 $15/$30/$ % $15/$40/$60 $15/$40/$ % Self Injectables (retail and mail order) 50% 50% 20% 20% The limits on Hospice Care have been removed. 12

15 PPO % Compared to PPO /60 Current Plan Renewal Plan Plan Name PPO % PPO /60 Benefit In-Network Out of Network In-Network Out of Network Lifetime Maximum $2,000,000 $2,000,000 and Immunizations) $25 copay 25% after deductible $30 copay 40% after deductible $35 copay 25% after deductible $40 copay 40% after deductible $35 copay 25% after deductible $40 copay 40% after deductible $2,500 per member Three-member maximum $3,500 per member Three-member maximum $2,000 per member Coinsurance 0% 25% 20% 40% (excludes deductible) N/A $7,000 per member Three-member maximum $3,500 per member $4,000 per member $7,000 per member Outpatient Lab $0 copay 25% after deductible $0 copay 40% after deductible Outpatient X-ray $0 copay 25% after deductible $0 copay 40% after deductible Outpatient Complex Imaging 0% after deductible 25% after deductible 30% after deductible 50% after deductible Hospital Inpatient 0% after deductible 25% after deductible 20% after deductible 40% after deductible $250 copay Deductible waived Paid as in-network 20% after $200 copay Deductible waived Paid as in-network Prescription Drugs $20/$40/$60 $20/$40/$ % $20/$40/$60 $20/$40/$ % Self Injectables (retail and mail order) 50% 50% 20% 20% The limits on Hospice Care have been removed. 13

16 HDHP % Compared to % HSA Compatible Current Plan Renewal Plan Plan Name HDHP % % HSA Compatible Benefit In-Network Out of Network In-Network Out of Network Lifetime Maximum $2,000,000 $2,000,000 and Immunizations) 20% after deductible 40% after deductible 20% after deductible 40% after deductible $30 copay (deductible waived) 40% after deductible $0 copay 25% after deductible 20% after deductible 40% after deductible 20% after deductible 40% after deductible $2,300 Individual $4,600 Family $4,500 Individual $9,000 Family $2,500 Individual $5,000 Family Coinsurance 20% 40% 20% 40% (includes deductible) $5,200 Individual $10,400 Family $13,500 Individual $27,000 Family $5,800 Individual $11,600 Family $5,000 Individual $10,000 Family $12,000 Individual $24,000 Family Outpatient Lab 20% after deductible 40% after deductible 20% after deductible 40% after deductible Outpatient X-ray 20% after deductible 40% after deductible 20% after deductible 40% after deductible Outpatient Complex Imaging 30% after deductible 50% after deductible 30% after deductible 50% after deductible Hospital Inpatient 20% after deductible 40% after deductible 20% after deductible 40% after deductible Prescription Drugs $15/$30/$50 after integrated Self Injectables (retail and mail order) 20% after deductible Paid as in-network 20% after deductible Paid as in-network 50% for formulary and non-formulary $15/$30/$ % after integrated 50% for formulary and non-formulary $15/$30/$50 after integrated 20% after integrated $15/$30/$ % after integrated 20% after integrated The limits on Hospice Care have been removed. 14

17 HDHP % Compared to % HSA Compatible Current Plan Renewal Plan Plan Name HDHP % % HSA Compatible Benefit In-Network Out of Network In-Network Out of Network Lifetime Maximum $2,000,000 $2,000,000 and Immunizations) 0% after deductible 25% after deductible 0% after deductible 25% after deductible $0 copay 25% after deductible $0 copay 25% after deductible 0% after deductible 25% after deductible 0% after deductible 25% after deductible $2,500 Individual $5,000 Family $5,000 Individual $10,000 Family $2,500 Individual $5,000 Family Coinsurance 0% 25% 0% 25% (includes deductible) $2,500 Individual $5,000 Family $10,000 Individual $20,000 Family $2,500 Individual $5,000 Family $5,000 Individual $10,000 Family $10,000 Individual $20,000 Family Outpatient Lab 0% after deductible 25% after deductible 0% after deductible 25% after deductible Outpatient X-ray 0% after deductible 25% after deductible 0% after deductible 25% after deductible Outpatient Complex Imaging 0% after deductible 25% after deductible 0% after deductible 25% after deductible Hospital Inpatient 0% after deductible 25% after deductible 0% after deductible 25% after deductible Prescription Drugs Self Injectables (retail and mail order) 0% after deductible Paid as in-network 0% after deductible Paid as in-network 0% after integrated 0% after integrated 25% after integrated 25% after integrated 0% after integrated 0% after integrated 25% after integrated 25% after integrated The limits on Hospice Care have been removed. 15

18 HDHP % Compared to % HSA Compatible Current Plan Renewal Plan Plan Name HDHP % % HSA Compatible Benefit In-Network Out of Network In-Network Out of Network Lifetime Maximum $2,000,000 $2,000,000 and Immunizations) 20% after deductible 40% after deductible 20% after deductible 40% after deductible $35 copay after deductible 40% after deductible $0 copay 25% after deductible 20% after deductible 40% after deductible 20% after deductible 40% after deductible $3,000 Individual $6,000 Family $5,000 Individual $10,000 Family $3,500 Individual $7,000 Family Coinsurance 20% 40% 20% 40% (includes deductible) $5,250 Individual $10,500 Family $15,000 Individual $30,000 Family $5,800 Individual $11,600 Family $6,000 Individual $12,000 Family $12,000 Individual $24,000 Family Outpatient Lab 20% after deductible 40% after deductible 20% after deductible 40% after deductible Outpatient X-ray 20% after deductible 40% after deductible 20% after deductible 40% after deductible Outpatient Complex Imaging 30% after deductible 50% after deductible 30% after deductible 50% after deductible Hospital Inpatient 20% after deductible 40% after deductible 20% after deductible 40% after deductible Prescription Drugs $15/$30/$60 after integrated Self Injectables (retail and mail order) 20% after deductible Paid as in-network 20% after deductible Paid as in-network 50% for formulary and non-formulary $15/$30/$ % after integrated 50% for formulary and non-formulary $15/$30/$50 after integrated 20% after integrated $15/$30/$ % after integrated 20% after integrated The limits on Hospice Care have been removed. 16

19 HDHP % Compared to % HSA Compatible Current Plan Renewal Plan Plan Name HDHP % % HSA Compatible Benefit In-Network Out of Network In-Network Out of Network Lifetime Maximum $2,000,000 $2,000,000 and Immunizations) 0% after deductible 25% after deductible 20% after deductible 40% after deductible $0 copay 25% after deductible $0 copay 25% after deductible 0% after deductible 25% after deductible 20% after deductible 40% after deductible $3,000 Individual $6,000 Family $6,000 Individual $12,000 Family $3,500 Individual $7,000 Family Coinsurance 0% 25% 20% 40% (includes deductible) $3,000 Individual $6,000 Family $16,000 Individual $32,000 Family $5,800 Individual $11,600 Family $6,000 Individual $12,000 Family $12,000 Individual $24,000 Family Outpatient Lab 0% after deductible 25% after deductible 20% after deductible 40% after deductible Outpatient X-ray 0% after deductible 25% after deductible 20% after deductible 40% after deductible Outpatient Complex Imaging 0% after deductible 25% after deductible 30% after deductible 50% after deductible Hospital Inpatient 0% after deductible 25% after deductible 20% after deductible 40% after deductible Prescription Drugs Self Injectables (retail and mail order) 0% after deductible Paid as in-network 20% after deductible Paid as in-network 0% after integrated 0% after integrated 25% after integrated 25% after integrated $15/$30/$50 after integrated 20% after integrated $15/$30/$ % after integrated 20% after integrated The limits on Hospice Care have been removed. 17

20 HDHP % Compared to % HSA Compatible Current Plan Renewal Plan Plan Name HDHP % % HSA Compatible Benefit In-Network Out of Network In-Network Out of Network Lifetime Maximum $2,000,000 $2,000,000 and Immunizations) 20% after deductible 40% after deductible 20% after deductible 40% after deductible $0 copay 40% after deductible $0 copay 25% after deductible 20% after deductible 40% after deductible 20% after deductible 40% after deductible $3,500 Individual $7,000 Family $6,000 Individual $12,000 Family $3,500 Individual $7,000 Family Coinsurance 20% 40% 20% 40% (includes deductible) $5,500 Individual $11,000 Family $12,000 Individual $24,000 Family $5,800 Individual $11,600 Family $6,000 Individual $12,000 Family $12,000 Individual $24,000 Family Outpatient Lab 20% after deductible 40% after deductible 20% after deductible 40% after deductible Outpatient X-ray 20% after deductible 40% after deductible 20% after deductible 40% after deductible Outpatient Complex Imaging 30% after deductible 50% after deductible 30% after deductible 50% after deductible Hospital Inpatient 20% after deductible 40% after deductible 20% after deductible 40% after deductible Prescription Drugs Self Injectables (retail and mail order) 20% after deductible Paid as in-network 20% after deductible Paid as in-network $15/$30/$50 after integrated 50% after integrated $15/$30/$ % after integrated 50% after integrated $15/$30/$50 after integrated 0% after integrated $15/$30/$ % after integrated 25% after integrated The limits on Hospice Care have been removed. 18

21 LIMITED BENEFIT 50/50 Compared to LIMITED BENEFIT 50/50 Current Plan Renewal Plan Plan Name LIMITED BENEFIT 50/50 LIMITED BENEFIT 50/50 Benefit In-Network Out of Network In-Network Out of Network Lifetime Maximum and Immunizations) $25,000 annual lifetime benefit maximum $2 million lifetime $25,000 annual lifetime benefit maximum $2 million lifetime 50% after deductible 50% after deductible 50% after deductible 50% after deductible $30 copay 50% after deductible $30 copay 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible $1,500 per member $3,000 per member $1,500 per member Coinsurance 50% 50% 50% 50% (excludes deductible) $4,500 per member $9,000 per member $4,500 per member $3,000 per member $9,000 per member Outpatient Lab 50% after deductible 50% after deductible 50% after deductible 50% after deductible Outpatient X-ray 50% after deductible 50% after deductible 50% after deductible 50% after deductible Outpatient Complex Imaging 50% after deductible 50% after deductible 50% after deductible 50% after deductible Limit Outpatient lab, x-ray and complex imaging limited to $500 max benefit per calendar year Outpatient lab, x-ray and complex imaging limited to $500 max benefit per calendar year Hospital Inpatient 50% after deductible 50% after deductible 50% after deductible 50% after deductible Outpatient Surgery (Hospital) Prescription Drugs Mail Order Drugs Self Injectables (retail and mail order) 50% includes any associated ancillary and professional charges 50% includes any associated ancillary and professional charges $200 copay +50% includes any associated ancillary and professional charges $200 copay +50% includes any associated ancillary and professional charges 50% after deductible Paid as in-network 50% after deductible Paid as in-network $15/50%/50% after integrated medical deductible 2.5 times retail copay; 31- to 90-day supply 50% after integrated $15/50%/50% +20% for generics; after integrated Not Covered 50% after integrated $10 generics; member pays 100% for Brand 3 times retail copay; 31- to 90-day supply 20% 20% $10 generics + 20%; member pays 100% for Brand Not Covered The limits on Hospice Care have been removed. 19

22 BASIC 1500 Compared to BASIC 1500 Current Plan Renewal Plan Plan Name BASIC 1500 BASIC 1500 Benefit In-Network Out of Network In-Network Out of Network Lifetime Maximum $2,000,000 $2,000,000 and Immunizations) $35 copay 45% after deductible $35 copay 45% after deductible $35 copay 45% after deductible $35 copay 45% after deductible $35 copay 45% after deductible $35 copay 45% after deductible $1,500 per member $3,000 per member $1,500 per member Coinsurance 30% 45% 30% 45% (excludes deductible) $4,500 per member $9,000 per member $4,500 per member $3,000 per member $9,000 per member Outpatient Lab 30% after deductible 45% after deductible 30% after deductible 45% after deductible Outpatient X-ray 30% after deductible 45% after deductible 30% after deductible 45% after deductible Outpatient Complex Imaging 30% after deductible 45% after deductible 30% after deductible 45% after deductible Limit Outpatient lab, x-ray and Outpatient Complex Imaging limited to $500 max benefit per calendar year Outpatient lab, x-ray and Outpatient Complex Imaging limited to $500 max benefit per calendar year Hospital Inpatient 30% after deductible 45% after deductible 30% after deductible 45% after deductible Outpatient Surgery (Hospital) 50% includes any associated ancillary and professional charges Prescription Drugs $15/50%/50% after integrated Mail Order Drugs Self Injectables (retail and mail order) 50% includes any associated ancillary and professional charges $200 copay +50% includes any associated ancillary and professional charges $200 copay +50% includes any associated ancillary and professional charges 30% after deductible Paid as in-network 30% after deductible Paid as in-network 2.5 times retail copay; 31- to 90-day supply 50% after integrated $15/50%/50% +20% for generics; after integrated Not Covered 50% after integrated $10 Generics; member pays 100% for Brand 3 times retail copay; 31- to 90-day supply 20% 20% $10 generics + 20%; member pays 100% for Brand Not Covered The limits on Hospice Care have been removed. 20

23 2008 INDEMNITY Compared to INDEMNITY Current Plan Renewal Plan Plan Name 2008 INDEMNITY INDEMNITY Benefit Out of Network Out of Network Lifetime Maximum $2,000,000 $2,000,000 and Immunizations) 30% after deductible 30% after deductible 30% after deductible 30% after deductible 30% after deductible 30% after deductible $1,000 per member Coinsurance 30% 30% (excludes deductible) $3,000 per member $1,000 per member $3,000 per member Outpatient Lab 30% after deductible 30% after deductible Outpatient X-ray 30% after deductible 30% after deductible Outpatient Complex Imaging 40% after deducible 40% after deducible Hospital Inpatient 30% after deductible 30% after deductible 30% after deductible 30% after deductible Prescription Drugs $20/$40/$60 $20/$40/$60 Self Injectables (retail and mail order) 50% 20% The limits on Hospice Care have been removed. 21

24 PPO 750 VALUE Plan Name New Plan PPO 750 VALUE Benefit In-Network Out of Network Lifetime Maximum $2,000,000 and Immunizations) $20 copay 40% after deductible $40 copay 40% after deductible $40 copay 40% after deductible $750 per member Three-member maximum Coinsurance 20% 40% (excludes deductible) $2,500 per member Three-member maximum $1,500 per member Three-member maximum $5,000 per member Three-member maximum Outpatient Lab $20 copay 40% after deductible Outpatient X-ray $20 copay 40% after deductible Outpatient Complex Imaging 30% after deductible 50% Hospital Inpatient 20% after deductible 40% after deductible Outpatient Surgery $200 copay +20% includes any associated ancillary and professional charges $200 copay +40% includes any associated ancillary and professional charges 20% after $150 copay Paid as in-network Prescription Drugs $15/$40/$60 $15/$40/$ % Self Injectables 20% 20% Mail Order Drugs 3 times retail copay; 31- to 90-day supply Not Covered 22

25 PPO 1000 VALUE Plan Name New Plan PPO 1000 VALUE Benefit In-Network Out of Network Lifetime Maximum $2,000,000 and Immunizations) $25 copay 40% after deductible $40 copay 40% after deductible $40 copay 40% after deductible $1,000 per member Three-member maximum Coinsurance 20% 40% (excludes deductible) $2,500 per member Three-member maximum $2,000 per member Three-member maximum $5,000 per member Three-member maximum Outpatient Lab $25 copay 40% after deductible Outpatient X-ray $25 copay 40% after deductible Outpatient Complex Imaging 30% after deductible 50% after deductible Hospital Inpatient 20% after deductible 40% after deductible Outpatient Surgery $200 copay +20% includes any associated ancillary and professional charges $200 copay +40% includes any associated ancillary and professional charges 20% after $200 copay Paid as in-network Prescription Drugs $15/$40/$60 $15/$40/$ % Self Injectables 20% 20% Mail Order Drugs 2.5 times retail; 31- to 90-day supply Not Covered 23

26 PPO 1500 VALUE Plan Name New Plan PPO 1500 VALUE Benefit In-Network Out of Network Lifetime Maximum $2,000,000 and Immunizations) $30 copay 40% after deductible $50 copay 40% after deductible $50 copay 40% after deductible $1,500 per member Three-member maximum Coinsurance 20% 40% (excludes deductible) $3,000 per member Three-member maximum $3,000 per member Three-member maximum $5,000 per member Three-member maximum Outpatient Lab $30 copay 40% after deductible Outpatient X-ray $30 copay 40% after deductible Outpatient Complex Imaging 30% after deductible 50% after deductible Hospital Inpatient 20% after deductible 40% after deductible Outpatient Surgery $200 copay +20% includes any associated ancillary and professional charges $200 copay +40% includes any associated ancillary and professional charges 20% after $200 copay Paid as in-network Prescription Drugs $15/$40/$60 $15/$40/$60 +20% Self Injectables 20% 20% Mail Order Drugs 2.5 times retail; 31- to 90-day supply Not Covered 24

27 PPO /60 New Plan Plan Name PPO /60 Benefit In-Network Out of Network Lifetime Maximum $2,000,000 and Immunizations) $30 copay 40% after deductible $50 copay 40% after deductible $50 copay 40% after deductible $3,000 per member Coinsurance 20% 40% (excludes deductible) $4,000 per member $6,000 per member $8,000 per member Outpatient Lab $0 copay 40% after deductible Outpatient X-ray $0 copay 40% after deductible Outpatient Complex Imaging 30% after deductible 50% after deductible Hospital Inpatient 20% after deductible 40% after deductible Outpatient Surgery $200 copay +20% includes any associated ancillary and professional charges $200 copay +40% includes any associated ancillary and professional charges 20% after $200 copay Paid as in-network Prescription Drugs $20/$40/$60 $20/$40/$ % Self Injectables 20% 20% Mail Order Drugs 2.5 times retail; 31- to 90-day retail Not Covered 25

28 PPO 10, % New Plan Plan Name PPO 10, % Benefit In-Network Out of Network Lifetime Maximum $2,000,000 and Immunizations $15 copay 25% after deductible $15 copay 25% after deductible 0% after deductible 25% after deductible $10,000 Individual $10,000 Family Coinsurance 0% 25% (excludes deductible) $10,000 Individual $10,000 Family $10,000 Individual $10,000 Family $20,000 Individual $20,000 Family Outpatient Lab 0% after deductible 25% after deductible Outpatient X-ray 0% after deductible 25% after deductible Outpatient Complex Imaging 0% after deductible 25% after deductible Hospital Inpatient 0% after deductible 25% after deductible 0% after deductible Paid as in-network Prescription Drugs $20/$40/$60 $20/$40/$ % Self Injectables 20% 20% Mail Order Drugs 2.5 times retail; 31- to 90-day retail Not Covered 26

29 UTAH 2500 COINSURANCE Plan Name New Plan UTAH 2500 COINSURANCE Benefit In-Network Out of Network Lifetime Maximum $2,000,000 and Immunizations 20% after deductible 40% after deductible $0 copay shows both 40% and 25% after deductible 20% after deductible 40% after deductible $2,500 per member Coinsurance 20% 40% (excludes deductible) $5,000 per member $5,000 per member $10,000 per member Outpatient Lab 20% after deductible 40% after deductible Outpatient X-ray 20% after deductible 40% after deductible Outpatient Complex Imaging 30% after deductible 50% after deductible Hospital Inpatient 20% after deductible 40% after deductible 20% after deductible Paid as in-network Prescription Drugs $15/$40/$60 $15/$40/$ % Self Injectables 20% 20% Mail Order Drugs 2.5 times retail; 31- to 90-day retail Not Covered 27

30 U = Upgrade, subject to medical underwriting Utah 2008 Buy up / Buy down guide D = Downgrade, no medical underwriting required YOUR CURRENT PLAN IS: YOUR RENEWAL PLAN IS: PPO /60 PPO /60 PPO /60 PPO 750 VALUE VALUE /60 PPO 1000 VALUE PPO /60 PPO VALUE 1500 PPO /60 PPO /60 D D D D D D D PPO /60 PPO /60 U D D D D D D PPO /60 PPO /60 U U D D D D D PPO /60 PPO /60 U U U D D D D PPO /60 PPO /60 U U U U U U D PPO /60 PPO /60 U U U U U U U D PPO % PPO /60 U U U U U U D PPO % PPO /60 U U U U U U U D PPO HSA % % HSA U U U U U U U U PPO HSA % % HSA U U U U U U U U PPO HDHP % % HSA U U U U U U U D PPO HDHP % % HSA U U U U U U U U PPO HDHP / % HSA U U U U U U U U PPO BASIC /55 BASIC 1500 U U U U U U U U LIMITED 50/50 LIMITED BENEFIT 50/50 U U U U U U U U 28

31 PPO /60 PPO /60 PPO HDHP % PPO HDHP % PPO HDHP /60 UTAH 2500 COINSURANCE UTAH BASIC LIMITED 50/50 PPO 10, % UTAH INDEMNITY D D D D D D D D D U D D D D D D D D D U D D D D D D D D D U D D D D D D D D D U D D D D D D D D D U D D D D D D D D U D D D D D D D D D U D D D D D D D D U U U U D U U D D U U U U U U U D D U D D D D D D D D U U U U U U U D D U U U U U U U D D U U U U D D D D D U U U U U U U U U U 29

32 UTAH Plan Change Requirements BENEFIT CHANGES WHEN ELIGIBLE REQUEST MUST BE RECEIVED REQUIRED DOCUMENTATION UPGRADE MEDICAL BENEFITS (to include adding Medical Plans to existing medical plans) DOWNGRADE MEDICAL BENEFITS ADD DENTAL TO EXISTING MEDICAL PLANS (refer to Dental Guidelines) ADD LIFE TO EXISTING MEDICAL PLANS (refer to Life Underwriting Guidelines) ADD ANOTHER CLASS OF EMPLOYEE COVERAGE New Business During the initial plan year a group may only change plans 6 months post sale (no changes are allowed within the 4-month period prior to the renewal date). Existing Business Upgrades are allowed once* in a 12-month rolling period, limited to the 8-month period following the renewal date. Example: A 1-1 renewal may request a plan change through 8-1. New Business During the initial plan year a group may only change plans 6 months post sale (no changes are allowed within the 4-month period prior to the renewal date) Existing Business Downgrades are allowed twice* in a 12-month rolling period, limited to the 8-month period following the renewal date. Example: A 1-1 renewal may request a plan change through 8-1. Anytime Anytime Renewal date only On Renewal request must be submitted on or prior to the effective date of the renewal. Off Renewal request must be submitted 30 days prior to the requested effective date. On Renewal request must be submitted on or prior to the effective date of the renewal. Off Renewal request must be submitted 30 days prior to the requested effective date. On Renewal request must be submitted on or prior to the effective date of the renewal. Off Renewal request must be submitted two weeks prior to the requested effective date. On Renewal request must be submitted on or prior to the effective date of the renewal. Off Renewal request must be submitted two weeks prior to the requested effective date. Request must be submitted on or prior to the effective date of the renewal. **Buy Ups are subject to Medical Underwriting and may receive a new RAF based on medical conditions reviewed A new employer application (complete pages 1 and 4 and indicate the requested effective date) or a letter from the group requesting the change. 2. Completed Employee Change of Coverage application. 3. A copy of the most recent filed 3H. 4. A Joinder agreement where applicable. 1. A Plan Sponsor Signature Page or a new employer application (complete pages 1 and 4 and indicate the requested effective date or a letter from the group requesting the change) or a letter from the group requesting the change. 2. Completed Employee Change of Coverage application. 3. A Joinder agreement where applicable. 1. A new employer application (complete pages 1 4) is required for all dental adds. Plan Sponsor Signature Page or a letter from the group requesting the change may be submitted in addition to the ER application. 2. New employee enrollment forms are required for all employees enrolling or declining dental benefits (please provide a copy of the ID cards for those employees waiving coverage). 1. A new employer application (complete page 1, 2 and 4) is required for all life adds. Plan Sponsor Signature Page or a letter from the group requesting the change may be submitted in addition to the ER application. 2. New employee enrollment forms are required for all employees enrolling or declining life benefits (if the group is electing 100% contribution 100% participation is required). 1. A letter from the group requesting the change or a new employer application. 2. New employee enrollment forms for all eligible part-time employees who are enrolling or declining the coverage (please provide a copy of the ID cards for those employees waiving coverage). 3. A copy of the most recent filed 3H. NAME CHANGE Anytime Anytime 1. A letter from the group requesting the change. 2. A completed name change form. 3. A copy of the most recent filed 3H. BWP CHANGE DOWNGRADES New hires must always submit an enrollment form, pages 1 4 DENTAL AND LIFE ADDS UPGRADES** May be requested anytime. Can only be requested once in a 12-month rolling period NO EXCEPTIONS. Anytime a change in coverage is across platforms an Employee Change of Coverage application is required. Require all employees to complete an enrollment or waiver form (if applicable). Require all employees moving to the upgraded plan to complete the Employee Change of Coverage application. CHANGES TO THE RENEWAL DATE ARE NOT ALLOWED Renewal plan changes are counted towards the maximum number of allowable changes. Request must be submitted prior to the requested effective date. If a group makes a plan change within the same platform where more than 1 plan is involved, the Employee Plan Change Template or a letter may be submitted by the employer on company letterhead. The letter must list each individual employee, and what plan they are going to be enrolled in (regardless if the employee is moving plans). 1. A letter from the group requesting the change or a new employer application. If a group makes a plan change within the same platform where more than 1 plan is involved and more than 1 platform is involved, the Employee Plan Change Template or a letter must be submitted by the Employer on company letterhead. This letter must list each individual employee and the plan they are enrolling to (regardless if the employee is moving plans). Additionally, any employee moving platforms must complete the Employee Change of Coverage application.

33 Frequently asked questions How do I secure a quote for Dental and Life coverage? If you are already participating in an Aetna Group Life product, your plan options are included in your renewal package. If you would like to add new life coverage, please contact your broker or the Aetna Sales Support Unit at What are participation requirements? Your plan is contingent upon meeting participation guidelines as follows: n Employers with 2 to 9 employees: Enrollment in an Aetna plan must be equal to 100 percent of total eligible employees excluding valid waivers, such as coverage through a spouse. Waiver forms are required. n Employers with 10 to 50 employees: Enrollment in an Aetna plan must be equal to 75 percent of eligible employees excluding valid benefit waivers, such as coverage through a spouse. Waiver forms are required. n Option sales alongside other carriers: Standard Participation of 75 percent of all eligible employees must be met in order for a group to qualify for coverage. How are renewal rates calculated? Renewal rates include census characteristics, trends in health care costs, coverage selected (single vs. family), location of employees, our group s benefits and demographics. Current medical and pharmacy trend is also an important component of your medical premium. Some of the most significant causes for increases include: n Advances in medical technology and new drug development n An aging population n Increased use of health services n Escalating costs of treatment for serious illness n Employee contributions shifting medical expenses from the public to the private sector Can I get a blended (i.e., composite) rate? n Tabular rates (rates for individual employees based on age, rating area and benefit tier) allow for more accurate premiums. n Composite rates are available in Utah for employers with 10 or more employees. n If you have had a census increase or decrease of less than 20 percent from your prior year s census, your rating calculation will not change. For example, if you were composite rated last year with 10 employees, and now you have 9 employees, you will still receive composite rating since your change in census is less than 20 percent. This policy serves to reduce the frequency of employees having to switch between tabular and composite rates from year to year. 31

34 Besides alternative plans presented as part of our proposal, are there additional options that we may consider? If available, Aetna has included a number of lower cost alternative plan designs for your consideration. Generally, the alternative plans listed in your proposal do not require underwriting approval and may represent potential savings versus your current plan design. There are, however, richer plan options from this portfolio that may not be included in your renewal, but would be available for quoting and may require underwriting approval. n Utah now offers Pick-A-Plan 3, which will allow an employer to offer any 3 of the 15 available plans. A change to a plan that is considered an upgrade will require medical underwriting approval. One person must enroll and remain enrolled in each plan for it to be active. n Rates for medical are guaranteed for a 12-month period. n If there is an employee on COBRA and the employer moves plans, the former employee has to move as well. How much may our employees contribute to premiums? You may choose to have your employees pay a portion of the medical premium up to a maximum of 50 percent of the employee only rate. For Life coverage, the employer must contribute 100 percent of the cost for groups with 2 to 9 lives and at least 50 percent of the cost for groups with 10 to 50 lives (excluding Optional Dependent Life). For Pick-A-Plan 3, the employer must contribute 50 percent of the employee premium OR the employer may choose to offer a defined contribution of at least $120 or the actual cost of the plans picked, whichever is less. How much may our employees dependents contribute to premiums? You may choose to have your employees pay all or part of the premium cost for their dependent coverage. Are new ID cards issued at renewal time? If you are covered under a new plan, new ID cards will be issued. ID cards will be sent directly to enrollee s home address. 32

35 Special notices Out-of-state employees Aetna will offer the in-state portfolio and rating structure to out-of-state employees that live in an out-of-state network area. Out-of-state employees that do not live in an out-of-state network area will be eligible for the in-state indemnity plans. Renewing plan sponsor 1. Renewal plan sponsors are eligible for this solution upon their next renewal only. 2. Beginning with February 1, 2008 renewals, requests for in-state PPO offerings for out-of-state employees must be sent to underwriting. 3. If a renewing plan sponsor has a current 2007 in-state PPO plan with out-of-state PPO employees, and wants the in-state plan for new out-of-state employees, all other out-of-state PPO membership must also move to an in-state PPO plan. If the employee does not reside in an Aetna PPO network, he or she will be offered the in-state indemnity plan. 4. If renewing plan sponsors do not have a current 2007 in-state plan, they must switch to a currently marketed in-state plan in addition to offering their out-of-state employees the in-state plan. Underwriting requirements n n Plan sponsors must have 51 percent of their employees living within the Headquartered State. The rating structure will follow the Headquartered State rating methodology. 33

36 Limitations and exclusions Medical These plans do not cover all health care expenses and include exclusions and limitations. Members should refer to their plan documents to determine which health care services are covered and to what extent. The following is a partial list of services and supplies that are generally not covered. However, the plan documents may contain exceptions to this list based on state mandates or the plan design purchased. Aetna PPO & Indemnity All medical or hospital services not specifically covered or which are limited or excluded in the plan documents. n Charges related to any eye surgery mainly to correct refractive errors n Cosmetic surgery, including breast reduction n Custodial care n Dental care and X-rays n Donor egg retrieval n Experimental and investigational procedures n Hearing aids n Immunizations for travel or work n Infertility services, including, but not limited to, artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI and other related services, unless specifically listed as covered in the plan documents n Nonmedically necessary services or supplies n Orthotics, as specified in the plan n Over-the-counter medications and supplies n Reversal of sterilization n Services for the treatment of sexual dysfunction or inadequacies, including therapy, supplies or counseling n Special-duty nursing n Weight control services including surgical procedures, medical treatments, weight control/loss programs, dietary regimens and supplements, appetite suppressants and other medications; food or food supplements, exercise programs, exercise or other equipment; and other services and supplies that are primarily intended to control weight or treat obesity, including Morbid Obesity or for the purpose of weight reduction, regardless of the existence of comorbid conditions Aetna PPO and Indemnity: Pre-existing conditions exclusion provision These plans impose a pre-existing conditions exclusion, which may be waived in some circumstances (that is, creditable coverage) and may not be applicable to you. A pre-existing conditions exclusion means that if you have a medical condition before coming to our plan, you might have to wait a certain period of time before the plan will provide coverage for that condition. This exclusion applies only to conditions for which medical advice, diagnosis or treatment was recommended or received, or for which the individual took prescribed drugs within six months. Generally, this period ends the day before your coverage becomes effective. However, if you were in a waiting period for coverage, the six-month period ends on the day before the waiting period begins. The exclusion period, if applicable, may last up to 12 months from your first day of coverage, or if you were in a waiting period, from the first day of your waiting period. 34